Condottieri from Blackwater have been much in the news lately. Here’s a roundup of recent stories:

WASHINGTON (CNN) — Security contractors in Iraq use some over-the-top tactics and overreact at times, a top U.S. general in Iraq said Friday.

Many in Iraq have witnessed security contractors operating in a questionable fashion, said U.S. Army Brig. Gen. Joseph Anderson, chief of staff for the Multi-National Corps in Iraq.

“I can certainly say I’ve seen them do some tactics that I thought were over the top. But that’s something we’ve got to keep working out,” Anderson said in a briefing to Pentagon reporters via teleconference from Iraq.

His comments soon after Defense Secretary Robert Gates said he wants closer oversight of Pentagon contractors in Iraq. Gates has dispatched a team there to review accountability and oversight.

Anderson did not offer specific examples of incidents he had seen.

Over the top? Let’s help the General out with some specific incidents:

BAGHDAD — On Sept. 9, the day before Army Gen. David Petraeus, the U.S. military commander in Iraq, and U.S. Ambassador Ryan Crocker told Congress that things were getting better, Batoul Mohammed Ali Hussein came to Baghdad for the day.

A clerk in the Iraqi customs office in Diyala province, she was in the capital to drop off and pick up paperwork at the central office near busy al Khilani Square, not far from the fortified Green Zone, where top U.S. and Iraqi officials live and work. U.S. officials often pass through the square in heavily guarded convoys on their way to other parts of Baghdad.

As Hussein walked out of the customs building, an embassy convoy of sport-utility vehicles drove through the intersection. Blackwater security guards, charged with protecting the diplomats, yelled at construction workers at an unfinished building to move back. Instead, the workers threw rocks. The guards, witnesses said, responded with gunfire, spraying the intersection with bullets.

Hussein, who was on the opposite side of the street from the construction site, fell to the ground, shot in the leg. As she struggled to her feet and took a step, eyewitnesses said, a Blackwater security guard trained his weapon on her and shot her multiple times. She died on the spot, and the customs documents she’d held in her arms fluttered down the street.

At least one other Iraqi was killed in the same incident.

Three days later, Blackwater guards were back in al Khilani Square, Iraqi government officials said. This time, there was no shooting, witnesses said. Instead, the Blackwater guards hurled frozen bottles of water into store windows and windshields, breaking the glass.

That’s certainly an unusual tactic. I wonder what it was supposed to accomplish?

Earlier this year:

BAGHDAD — The Blackwater incidents cited by Iraq’s Interior Ministry as reason for the security firm to be barred from operating in Iraq include the deaths of four people with ties to Iraq’s government-funded television network.

The first of those was the Feb. 2 shooting death of Suhad Shakir, a reporter with the Al Atyaf channel, as she was driving to work. She died outside the Foreign Ministry near the Green Zone, where top U.S. and Iraqi officials live and work.

Five days later, three Iraqi security guards were gunned down inside the fortified compound that houses the government-funded Iraqi Media Network, which is also known as Iraqiya.

Habib Sadr, the network’s director general, said the three guards, members of Iraq’s Facilities Protection Service, were at their post at the back of the complex. A towering blast wall was a short distance in front of them to protect the compound from Haifa Street, which is notorious for car bombings and drive-by shootings.

According to Sadr and Interior Ministry officials, the three were picked off one by one by Blackwater snipers stationed on the roof of the 10-story Justice Ministry about 220 yards away on the opposite side of the street.

…

“The investigation showed that they were killed in cold blood and in an aggressive and unjustified way,” Sadr said. “I believe that if this happened in any state in the United States and they killed an animal, it would be condemned by all.

“They were target practice,” Sadr said.

The most recent and most notorious incident happened on the 16th of this month:

First, here’s Blackwater’s version:

Sunday’s firefight took place about noon (4 a.m. ET) near Nusoor Square, in western Baghdad. Marty Strong, vice president of Blackwater USA, said the group’s employees were protecting an American official when they were hit by “a large explosive device, then repeated small-arms fire — and to the point where it disabled one of the vehicles, and the vehicle had to be towed out of the firefight.” (Posted 7:30 p.m.)

That isn’t the way the Iraqis saw it:

U.S. officials provided few details of the shooting, which took place as Blackwater guards were escorting unidentified State Department officials through a central Baghdad neighborhood.

Witnesses said the dead included the driver of one car and a mother and child whom he was transporting. Police said the dead included five Iraqi police officers who’d tried to help. At least nine cars were set on fire.

State Department spokesman Sean McCormack described the incident as a “firefight,” but three people who claimed to have witnessed the shooting said that only the Blackwater guards were firing.

The witnesses said the shooting began after a convoy of four gray armored vehicles drove into Al Nisour Square, a major intersection in central Baghdad. Iraqi police stopped traffic to let the convoy pass, the witnesses said. One car, however, drove up from behind the traffic to squeeze into a spot at the front. As it did, the security contractors opened fire, the witnesses said.

The young driver was killed instantly, but the shooting continued. The witnesses said they believe a grenade was launched at the car, which burst into flames, killing a young mother and baby in the back seat.

When Iraqi police approached to help the people in the burning car, the contractors started shooting at them. They also shot at a minivan and a bus, the witnesses said.

On Monday, the charred white vehicle where the man, mother and child were said to have died was pushed to the side of the road.

Police said 15 people were wounded. None of the dead and wounded was an armed insurgent, police said.

Apparently there’s a videotape of the whole incident. The number of dead is variously reported as five, nine, and eleven.

Afrah Sattar, 27, was on a bus approaching the square when she saw the guards fire on the white car. She and her mother, Ghania Hussein, were headed to the Certificate of Identification Office in Baghdad to pick up proof of Sattar’s Iraqi citizenship for an upcoming trip to a religious shrine in Iran.

When she saw the gunmen turn toward the bus, Sattar looked at her mother in fear. “They’re going to shoot at us, Mama,” she said. Her mother hugged her close. Moments later, a bullet pierced her mother’s skull and another struck her shoulder, Sattar recalled.

As her mother’s body went limp, blood dripped onto Sattar’s head, still cradled in her mother’s arms.

“Mother, mother,” she called out. No answer. She hugged her mother’s body and kissed her lips and began to pray, “We belong to God and we return to God.” The bus emptied, and Sattar sat alone at the back, with her mother’s bleeding body.

“I’m lost now, I’m lost,” she said days later in her simple two-bedroom home. Ten people lived there; now there are nine.

“They are killers,” she said of the Blackwater guards. “I swear to God, not one bullet was shot at them. Why did they shoot us? My mother didn’t carry a weapon.”

Under a decree from Paul Bremer, the “contractors” can’t be prosecuted by the Iraqis for crimes committed in Iraq. As civilians they don’t fall under the UCMJ. Their actions in a foreign country don’t fall under US law.

Founded in 1996 by Erik Prince, a former Navy Seal, multimillionaire and conservative Republican donor, Blackwater began as a training facility for police and the military but began offering security services after the Sept. 11, 2001, terrorist attacks. Prince, whose father helped bankroll conservative Christian organizations such as Focus On Family and Family Research Council, has given at least $225,000 to the Republican Party and its candidates.

The Congressional Research Service said that as of May there were 987 Blackwater security contractors in Iraq. The director of the Private Security Company Association of Iraq told Congress in 2006 that there were 48,000 contractors from 181 companies providing security in Iraq.

I see here that Mitt Romney is needling Democratic presidential candidates over a moment in last night’s debate where they refused to condemn a Massachusetts schoolteacher for reading a children’s book about a prince who marries another prince. Romney is complaining that Dems didn’t pretend to be shocked at the thought of “young children learning about same-sex marriage in the second grade.”

This here is the traditional right-wing double standard. When the rich bleed the poor, that’s business as usual; when the poor try to keep from being bled, that’s “class warfare”. When bigots beat up gays, that’s business as usual; when gays protest being beaten, that’s “special rights” or “recruitment”.

Update: And two minutes after posting, I see that the Senate has passed the Matthew Shephard Act, which expands existing federal hate crime laws to cover bias based on the victim’s sexual orientation, gender identity, etc. I’ve got mixed feelings about this. On the plus side, if we’re going to have hate crime laws, they ought to cover this. On the minus, I’m not thrilled with hate crime laws in general. They put still more power into the hands of prosecutors, who are plenty powerful enough nowadays.

The entire USA PATRIOT Act is unconstitutional on its face. Nevertheless, we applaud the courageous judge who struck down two of its provisions while at the same time mourning that a judge would have to be courageous to do so.

The case arose from the Madrid train bombings of a few years back. The FBI, misinterpreting some partial fingerprint evidence, secretly searched and wiretapped an American citizen, a lawyer, mostly because he is a Muslim. He was falsely accused, arrested … and he sued.

He won.

“In place of the Fourth Amendment, the people are expected to defer to the executive branch and its representation that it will authorize such surveillance only when appropriate.”

The government “is asking this court to, in essence, amend the Bill of Rights, by giving it an interpretation that would deprive it of any real meaning. The court declines to do so,” [Judge] Aiken said.

I think there’s an idea here without a clear term to point to it: ideologies that require or encourage a kind of willful ignorance. Those can be cured, but only by breaking with the ideology.

Frex, a lot of economic determinists (Marxists and neoclassical economists) seem to have the idea that they don’t need to know much about the world to understand it, because their economic models give them the fundamental insights. I think the screwups in Iraq have largely been caused by very smart people whose ideology led them to think that they had grasped the essentials of the situation there, despite scary stuff like not knowing the difference between Shia and Sunni. I think there’s also a widespread idea in management that you should be able to manage things whose details you don’t understand all that well. (But that’s way outside my field or interests, so I may just be misunderstanding.)

The hard thing is, you *have* to have simplifying models—they’re what make a fiercely complex world usable. But your model can really screw you, by convincing you that you know the important stuff, even when you’re frightfully ignorant of the details. And people with very powerful or convincing models often get screwed in just this way, as they try to apply their powerful model from one situation into a different one. Even worse, some models’ strength is that they make for good rhetoric, and when tested against the real world, they fail horribly. But group decisionmaking is largely done through rhetoric—both national politics and internal politics of most groups. You can have disastrous ideas that win all the arguments, sound great, and reliably gain power—I’d say that the rhetoric about the Middle East being ripe for democracy, democracy leading to peace, etc., is a good example of that.

“Many of them are, or rather claim to be, his followers. They daub the Raven-in-Flight upon every wall where property is destroyed. Their captains carry letters of commission purporting to come from John Uskglass and they say he will shortly return to re-establish his reign in Newcastle.”

“And the Government believes them?” asked Strange in astonishment.

“Of course not! We are not so ridiculous. What we fear is a good deal more mundane—in a word, revolution. John Uskglass’s banner is flying everywhere in the north from Nottingham to Newcastle. Of course we have our spies and informers to tell us what these fellows are doing and thinking. Oh, I do not say that they all believe that John Uskglass is coming back. Most are as rational as you or I. But they know the power of his name among the common people. Rowley Fisher-Drake, the Member for Hampshire, has brought forward a Bill in which he proposes to make it illegal to raise the Raven-in-Flight. But we cannot forbid people to fly their own flag, the flag of their legitimate King.” Sir Walter sighed and poked a beefsteak upon his plate with a fork. “Other countries,” he said, “have stories of kings who will return at times of great need. Only in England is it part of the constitution.”

Today, this very day, forty-six years ago, Betty and Barney Hill drove down U.S. 3, right past my house and into history. They were about to become Patient Zero for Alien Abductions with Weird Medical Experiments, Missing Time, and Big-Eyed Extraterrestrials. The first and (we are told) best documented case of Alien Abduction Evah. There was a book. There was a made-for-TV movie. Magazine articles. Mentions in other books. Close Encounters of the Third Kind.X-Files.

Synopsis: In the early morning hours, Betty and Barney Hill were returning from a vacation in Montreal, Canada. As they traveled down Highway 3, just outside of Colebrook, New Hampshire, Betty first noticed a star that appeared to be moving. Bringing Barney’s attention to it, they watched it as they continued to drive. They realized that the star was moving and keeping pace with them as they negotiated the mountainous terrain.

Somewhere, outside of Indian Head, NH, they decided to stop the car and use binoculars to attempt to see what the object was. Barney left
the road and moved through the woods to get a closer look. By this time, the Hills’ realized that the star was a pancake-shaped object
which had moved to a position in front of their car at tree-top level. As Barney got closer to it, he observed two fin-like objects with
blinking red lights that appeared to detach from the fins, as the fins began coming out of the sides of the object.

Through binoculars, Barney could see humanoids standing in a large window looking at him. As he observed, all of the men except what Barney called the “leader”, turned and began operating levers and controls on a wall behind them. The leader continued staring at Barney and Barney could detect that the leader was telling him not to be afraid and that they were going to come down for him and bring him onboard.

Barney was filled with absolute terror and found that he could not take the binoculars away from his face. He claimed that the leader’s eyes
just bored into his head. Tearing the binoculars away from his eyes so hard that he broke the strap around his neck, he ran hysterically
back to the car screaming to Betty, “They are going to capture us!!”

Barney jumped into the car and began driving wildly. Shortly after this, the Hills’ heard a series of beeping sounds and this is where their memory of the experience ends. Later, they hear another series of beeping sounds and when they return to consciousness, they discover that they have traveled 35 miles from where their memory fails them. When they return home they also realize that 2 hours are unaccounted for.

Following this, the Hills’ are treated by a Boston psychiatrist, Dr. Benjamin Simon, and, under medical hypnosis, they recall the terrifying 2-hours of missing time.

This story is told in detail in a book by John Fuller, “The Interrupted Journey” and was made into a television movie by the same name.

I’ll be looking at Fuller’s account in some detail, but this will be long so I’ll put it below the cut.

The problem with relying solely on philosophy when it comes to discussing the ‘big picture’ about God and his role in the evolution of life, is that it too often gives cover to scientific stupidity.

I would much rather say ignorance instead of stupidity, believe me. But ignorance is a condition that can be remedied, assuming the ignorant party is interested in learning the truth. That is not the case with many conservatives and the journalists who pander to them. …

Another part of the problem—at least with regard to conservative journalists and how they cover science—is the narrow provincialism, born of the small social circle of people who make up the current conservative intellectual establishment, meaning, in the corridor between New York and Washington, D.C. [I’m a Red Sox fan, so shoot me.]

A friend of mine, who is also a longtime reader of National Review and the other conservative opinion journals, had some interesting comments about this a while back in an email, and I think he’s right on the money: “The problem with NRO is that it’s intellectually incurious. It’s gotten to be dull and airless because it’s not really interested in exploring new ideas and rethinking old ones in light of experience, but instead serving as a political rallying point. There is so much more to conservatism — or to be more precise, what interests, or should interest, conservatives — than what happens in Washington, but that’s all they seem to care about.”

For example, he might have ventured to query some Christians who are scientists and philosophers, ones who are not scared of Darwin. … But talking to anyone who might politely disprove the point is just not part of what Bethell, Gilder, Buchanan, Coulter & Co. are up to.

Also from John Farrell, 11 September 2007:

More depressing evidence of Christian documentary filmmakers who feel no need to be honest about what they are doing when they approach prospective interviewees to be in their films.

A couple of years ago, I welcomed a camera crew into my office for some interviews about Old Testament stories. The crew went away and I never heard from them again, until I e-mailed the production company last week to find out what ever became of the footage. A representative of that company promptly e-mailed me back and kindly sent out a screener of the DVD that is scheduled to release in October.

He was a good guy. He and Mike Ford considered one another “blood brothers,” and he spoke at Mike’s memorial in Minneapolis last fall, even though the effort of simply standing up was obviously a strain. He was a doer of quiet kindnesses, which counts for a very great deal.

Our thoughts are with his wife Harriet McDougal, the rest of the family, and everyone else who loved him.

Our bones have all kinds of functions. They provide shape. They provide support. They allow movement. They provide protection. They store minerals. They produce red blood cells.

Those last two functions aren’t so important on a trauma scene. What is important is that broken bones are highly vascular (they bleed), and sharp ends can cut other blood vessels.

If you were to ask me how many bones there are in a skeleton, I’d have to say “Beats the heck out of me.” The book answer is 206, but … well. Throughout our lives cartilage is turning to bone (somewhere around age 60, for example, the thyroid cartilage (the voicebox) starts to ossify). Whether you call bones that have fused one bone or two might be debated. Most people have four bones in their coccyx, but some have three, and some have two. Plus, you can have any number of sesamoids. Those are tiny round bones (the word means “seeds”) that form in tendons to reduce friction. They form in response to exercise. Everyone has at least two sesamoids: they’re the patellas (kneecaps).

Definition time! “Proximal” means “closer to the trunk.” “Distal” means “farther away from the trunk.” (On the trunk itself, “superior” means “closer to the top of the head,” while “inferior” means “farther away from the top of the head.”) “Lateral” means “toward the side” (right or left, away from the centerline.) “Medial” means “closer to the centerline.” “Dorsal” means “back,” “ventral” means “front.”

Bones come in several shapes: long (such as the femur (thighbone)), short (such as the carpals (wrist bones)), flat (such as the costals (ribs)), and irregular (such as the various vertebrae).

Joints too have several varieties: hinge (such as knee), ball-and-socket (such as hip), fused or fixed (such as in the pelvis), pivot (the joint between C-1 (the Atlas) and C-2 (the Axis) for example, which allows the head to turn from side to side), gliding (for example in the wrists), and saddle (uniquely in the base of the thumb).

Ligaments attach bones to bones. Tendons attach muscles to bones. Damage from pulling on ligaments is called a sprain. Damage from pulling on tendons and muscles is called a strain.

Damage to joints takes three forms: Distraction, subluxation, and dislocation. In distraction, the bones that form the joint are still in line, but the surfaces are separated. The binding ligaments aren’t ruptured. Subluxation is an incomplete dislocation; the joint has moved beyond its normal range, the alignment between the joint surfaces is distorted, but the articulating bones remain in contact. The binding ligaments may or may not be ruptured. In a dislocation (the old name is luxation), the joint is completely disrupted; the joint surfaces are no longer in contact. The binding ligaments are usually ruptured.

Just because a joint is dislocated doesn’t mean that one or more of the bones isn’t fractured, too. Without X-rays, you can’t tell for sure. So—hope for the best, but treat for the worst. Assume every dislocation includes one or more fractures.

Shoulder dislocations are fairly common. Falls, where the patient tries to catch himself with his hands, and motor vehicle accidents where the driver is grasping the wheel, are common causes. One common subluxation is “Nursemaid’s Elbow,” where the proximal head of the radius (the lower arm bone on the thumb side) is pulled out of alignment in the elbow joint. You see that in little kids who are holding hands with an adult; when the kid steps off a curb and suddenly all the weight of his body is suspended through one arm. Distraction — you see that in hanging, and when folks get entangled in machinery.

A fracture is when the body of the bone itself is disrupted or broken. Wrist fractures are the most common fractures in persons under age 65.

You can have a lot of fun memorizing bone names. (For example, the mnemonic for the bones in the wrist is “Some Lovers Try Positions That They Can’t Handle” for Scaphoid, Lunate, Triquetium, Pisiform, Trapezium, Trapezoid, Capitate, Hamate. (You can have even more fun memorizing the names and functions of the twelve cranial nerves, but that’s for another post.)

The most common wrist fracture is a fractured Scaphoid. That’s the bone on the thumb side that articulates to the radius (thumb-side forearm bone). The other forearm bone (little finger side) is the ulna. When you bend your elbow, the point of the elbow is the olecranon process on the proximal end of the ulna.

Oftentimes a fractured scaphoid presents as a “sprained wrist” that keeps hurting for four to six weeks. The most common mechanism of injury for a scaphoid fracture is a fall where you catch yourself on your outstretched hand, palm open and down.

There are all kinds of different fractures. You have your transverse fractures — they go from side to side at 90 degrees to the axis of the bone. You have your oblique fractures, your spiral fractures, your greenstick fracture (an incomplete fracture), your comminuted fracture (that’s where the bone shatters), your impacted fracture (one broken end is rammed into the other broken end, resulting in a bone that’s a bit shorter than it should be), and depressed fractures (you see them in skulls, but the sides of long bones aren’t immune) … lots of kinds of fractures. Your friendly EMTs have to know them because the book was written by the American Academy of Orthopaedic Surgeons, and the orthopods think fractures are fascinating. Therefore types of fractures’ll be on the test. But what you have to know in the field is this: It doesn’t matter to you and unless your name is Clark Kent you may not be able to tell.

The happy fact about strains, sprains, fractures, dislocations, all of the jolly trauma to the musculoskeletal system, is that they’re all treated the same way.

The only real categories you have to worry about are Open and Closed Fractures. In open fractures, the skin has been broken. In closed fractures it hasn’t. (Those used to be called “Compound” and “Simple” fractures. That’s old terminology. We don’t use it any more.) If the injury is bleeding, treat the bleeding first. Remember, bleeding falls under Circulation, and Circulation is C in the A-B-Cs.

Joint and bone injuries:

How to assess a hard-tissue injury: Look and feel for DOTS.

That is, the signs and symptoms are: a body part is

Deformed,

Open,

Tender, and/or

Swollen.

Deformity is generally obvious. If a guy has two elbows, one of them half-way down the forearm, you can figure there’s a fracture. If the shoulder has a step-off you can figure on a dislocation. A joint that’s locked in position is often a dislocated joint.

Open means an open wound. If someone got hit hard enough to break the skin, assume that the bone underlying that point is also broken. A guy chopping firewood hits his leg with his axe, assume fracture. A guy playing baseball gets hit on the arm hard enough to break the skin, assume a fracture. (Or, if you see bone ends sticking out … well, what do you think?)

Tender means “If you press on it and the guy says, ‘Ouch!’” (or “$*^#*^@!!!!!”) then it’s tender.”

Swollen means … well, swollen. That can be from bleeding around the injury site, or it can be from fluid going into the inter-cellular spaces around the injury site as part of the body’s immune reaction. In general, the body reacts to trauma by swelling at the site. The classic lump on the head is an example. Swelling can threaten the viability of the limb, through something called compartment syndrome. The various muscle groups in your limbs are inside of tough fibrous sheathes, or compartments. Fluid going into those compartments can have enough pressure that it overcomes blood pressure, creating, in effect, a tourniquet. This has all of the problems of a tourniquet that you applied, only without being as obvious, and not as easy to take off. You really do want to limit swelling as much as you can.

If a patient tells you “I broke my arm,” believe him.

The signs and symtoms go together so often that we abbreviate them: “PSD” for Painful/Swollen/Deformed. (“Hey, Bill, what to you have?” “Guy over there’s got a PSD left wrist….”)

A fun project for a rainy Saturday afternoon! Get a fresh turkey at the market. Using a pair of pliers and a hammer, break its thigh bone. Using your gloved hand, check what that feels like through the flesh. That’s what a broken bone feels like to you the provider (it feels considerably worse to the patient).

What to do about all these injuries: Throw rice at them. The mnemonic here is RICE. That stands for Rest, Ice, Compression, and Elevation.

Rest means that you don’t try to use the part any more. Muscle movement can make bone ends grate on each other (the word for broken bones grinding together is “crepitus,” and it feels nasty under your fingers; the patient can feel it too). I’ve seen people walking on broken legs, though. Part of that is because shock means that it stops hurting. Part of that is distracting injury. If a guy’s got a very painful injury one place he might not even notice a less-painful injury somewhere else. So, get the guy lying down and not moving. Fortunately you’re already doing this because you’re already treating for shock.

Ice means a cold pack. If you’re using genuine ice, put it in a plastic bag and wrap that bag in a towel before placing it on an injury. You don’t need to add frostbite to the guy’s other problems. Ice reduces swelling and reduces pain. Reducing pain is a good thing.

Elevation puts the injured part above the heart. This lets gravity help in reducing swelling and reducing pain.

After that comes Splinting.

Splinting provides the support that the bone formerly provided, but is no longer capable of giving. It stops further damage from occurring. Even if the bone isn’t broken, a splint at the site of a deep laceration will limit movement and help prevent more damage. Splinting also reduces pain.

Danger Will Robinson alert: You can kill people by splinting them, even if you do perfect splints.

If you get distracted by a fracture to the point you forget to check your patient’s airway, breathing and circulation, that guy will be dead. Fractures can be grotesque to look at, but they probably won’t kill the guy today. A blocked airway will kill him in the next five minutes.

If you have an open fracture and it’s bleeding, control the bleeding first before you consider splinting.

On to splinting. You can use almost anything quasi-stiff to make a splint. You’re building an exoskeleton. Rolled up newspapers, a copy of National Geographic, a pillow, a tree branch, and umbrella — anything. The rule for splints is that you want them to be BUFF. That is, Big, Ugly, Fat, and Fluffy. A narrow splint that cuts into the guy’s flesh isn’t going to help. You can pad the splint with the patient’s own clothing (you cut it off the injured part anyway, when you were examining it). I carry SAM splints, and suggest you put ‘em in your own first aid kit.

First thing to do: Manually immobilize the part. The patient is probably doing this himself, but you can have a bystander help with holding the bone or joint steady. Next, check movement, circulation, and sensation distal to the injury. Can you feel a pulse? Can the patient feel you touching him? Can the patient wiggle his fingers and toes? If you can’t feel the patient’s pulse in the affected limb (but you can in the other, unaffected limb), what you do next will depend on how long it’ll be before you can get the guy to definitive care (that is, to an emergency room). If it’s going to be over an hour, consider applying gentle, in-line traction until you can feel a pulse. But for heaven’s sake, be careful. Pulling the guy’s arm off is usually considered bad form.

For a broken (sprained, dislocated) joint, immobilize from the bone above to the bone below. For a broken bone, immobilize from the joint above to the joint below the injury. That is, for a broken forearm, you immobilize the wrist and the elbow. For a broken hip you immobilize the pelvis and the knee. You need a minimum of two ties on the splint above and two below to immobilize each part. I like to wrap the entire length of the splint with roller gauze to make sure the part is immobilized. Use wide, soft material to tie the splint in place. Triangular bandages are perfect for this. Strips of cloth (cut from the patient’s clothing if necessary) are great. Wire or fishing line is right out.

After you’ve applied the splint, check the patient’s circulation, sensation, and movement again. If you could feel the guy’s pulse before you applied the splint, but you can’t feel it now, you might have the splint on too tight. You don’t want to cut off circulation. If you’ve lost the pulse, or his hand is suddenly numb, or some such thing, take the splint off and reapply it.

And keep checking airway, breathing, and circulation.

Human necks are delicate and lots of important things go through them. Any time you have a serious mechanism of injury (e.g. high speed automobile crash, fall over three times the patient’s height), or any time you see any injury above the collarbone, assume the patient’s neck is broken until Mr. X-ray tells you different. What to do then: Hold the patient’s head steady in a neutral, in-line position until the nice ambulance guys get there. (Note: there are protocols for clearing the cervical spine in the field. Don’t do it unless you do this kind of thing a lot, are supremely confident, and have a desire to see yourself in court explaining your decision.) I have personally had a patient with a fractured C-2, who had suffered a fall from a standing height, whose only signs were a small abrasion on the point of the chin and in the center of the forehead.

How to hold c-spine: Stand or kneel behind the patient (after explaining what you’re going to do and getting his permission to do it), spread your fingers, rest the little-finger side of your hands on his shoulders, and with the tips of the fingers hold his head up and pointing straight forward.

If the patient is unconscious you can skip the “get permission” part.

If you are the first one on scene at an automobile accident, after calling 9-1-1 and setting out flares, pretty much 100% of what you’ll be doing is holding c-spine, assuming that airway, breathing, and circulation are okay. Note: Training bystanders to hold c-spine is fast, easy, and frees you up to do other things.

The femur is one of the largest and strongest bones in the body. It takes significant force to break one. Once it’s broken, there are several life-threats present. One is the embolus. You have large veins present in the leg. Fat, marrow, or a blood clot from the injury site can get sucked into one of the large veins and carried to the heart or lungs. Your pulmonary embolus can kill you dead, fast. Second is bleeding: the femoral artery, a blood vessel the diameter of your thumb, runs along the bone along the medial aspect. If sharp bone ends cut that artery, you can bleed out very rapidly.

The large muscles of the leg (quadriceps, biceps femoralis) contract on injury. (The only trick a muscle has is to contract.) That makes the sharp ends of the bone override, and increases the danger of cutting a major vessel.

Internal bleeding at the injury site, apart from the femoral artery, can also cause significant blood loss. As the leg muscles contract the shape of the leg changes with the thigh getting shorter and wider, providing more volume for the blood to go into.

The field intervention for all of this is the traction splint. Without traction splinting a fractured femur is 80% fatal. With traction splinting, it’s only 20% fatal. There are several kinds of manufactured tractionsplints. No one expects you to carry one in the trunk of your car on the off-chance you’ll be first on scene where there’s a fractured femur. Instead, let’s talk about an improvised traction splint.

Here’s one way to improvise a traction splint: Gather together a stick that’s longer than the patient’s leg, a coffee cup, some cord, and some strips of cloth.

Check circulation, sensation, and movement in the foot on the injured side. Cut or tear away the clothing from the injured leg. (That’ll give you your cloth strips right there.) This intervention is only for an isolated mid-shaft femur fracture. Hips are different, and a fracture that involves the knee is something else again. Tie an ankle hitch around the ankle of the injured leg using a strip of cloth, a triangular bandage, or something else wide and soft. (Cutting off circulation is a bad idea.) Take the patient’s shoe from the affected side and put it, sole up, into the patient’s crotch. Put one end of the stick (umbrella, ski pole, what-may-have-you) into the shoe. Lay the stick along the length of the leg. Put the coffee cup over the other end of the stick. Tie the cord to the ankle hitch, then put it through the handle of the coffee cup. Pull on the cord, using the handle of the cup as a pulley. Continue, gently, until the injured leg is the same length as the uninjured leg. The patient will usually tell you that the pain has diminished when you have it right. The usual amount of traction is around 15 pounds. Tie off the cord to maintain tension. Tie the stick to the leg using more strips of cloth. Check circulation, sensation, and movement in the foot again. Continue to recheck the splint at regular intervals.

The pelvis is also a very strong structure that requires significant force to fracture. Again, bleeding is a major risk. Any movement in a fractured pelvis risks further injury, including cutting blood vessels. So, you want to keep it from moving.

Assessing the pelvis: Press in, press down, and pull up on the wings of the pelvis. Press down on the pubic bone. Any movement, crepitus, instability, pain or tenderness suggests a fracture.

What to do: Check circulation, sensation, and movement in both feet. Take a sheet. Fold it until it’s approximately four inches wide. Run it from side to side under the pelvis (to do this: run it under the small of the back, or under the thighs, then work it until it’s in place). Take the folded sheet around in front of the pelvis and tie the ends together with a square knot. Insert a stick into the knot and tighten down as you would a tourniquet until snug. Recheck circulation, sensation, and movement.

Flail chest is two or more contiguous ribs broken at two or more places. This produces a section of the chest wall that’s just floating free. You see this in injuries such as when someone’s chest hits a steering wheel. You’ll note that the patient is having difficulty breathing, and you’ll note paradoxical movement: That is, when the chest is expanding while the patient is inhaling, part of the chest wall is going in. When the patient is exhaling, while the rest of the chest is contracting, that part of the chest wall is going out.

What to do about it: First, stabilize the flail segment with your hand. Then, tape a bulky dressing (towel, pillow, large folded cloth) over the area. Be ready to perform artificial ventilation.

The general treatment for anything involving the upper extremities (arms, shoulders) is the sling-and-swathe. For forearms and wrists, put on a splint first. For upper arm or shoulder, just the sling-and-swathe is enough.

First, check circulation, sensation, and movement in the hand on the affected side. Remove watches and rings, since when the hands swell (and they will) those can cause loss of circulation and tissue death downstream. Splint wrist (from bone to bone, metacarpals to radius/ulna) or forearm from joint to joint (wrist to elbow).

To do a sling and swathe: Take one triangular bandage. Lay it on the chest so that the long edge is straight up and down and the 90-degree angle faces toward injured side. Tie a knot in that 90-degree angle to make a pocket for the elbow. Now put the hand from the injured limb in the “pledge allegiance” position (on the chest above the heart). Wrap the bottom point of the triangle up, around the neck and down to meet the other point. Tie them together on the side of the neck. (If you put your knot in the back it’ll be uncomfortable for the patient, and impossible for you to get to once the patient is on a stretcher.) The sling should take the weight of the limb. Now, take a second triangular bandage and tie it over the upper arm on the injured side and under the arm on the uninjured side. The purpose of this is to hold the arm tight against the ribs so it doesn’t go flapping around. This keeps an elbow or a shoulder from moving, and splints the humerus.

Look for Battle’s Sign (bruising over the mastoid process—the area just behind the ear) and/or “raccoon eyes” (bruising around both eye sockets). (These are both late signs.) Look for blood, particularly if mixed with clear fluid, coming from the nose or ears. Look and feel for depressed areas in the skull.

What to do about it: Assume the neck is also broken and keep it stabilized. Keep the patient’s upper body slightly elevated, since the brain is going to swell and you can help a bit by letting gravity move fluid away from the brain. Watch for the pulse to get slower, for blood pressure to go up, and for respiration to become patterned, then cease. (Note: if you see an isolated head injury and blood pressure is going down while heartrate is going up, there’s another injury somewhere that you haven’t found yet. See what you can do to locate it and treat it.)

Take good notes on the patient’s mental status. Particularly note if the patient was unconscious, woke up, then became unconscious again. A neurosurgeon somewhere wants to know the duration of that lucid interval and will thank you if you’ve written down the times.

That’s pretty much it for broken and dislocated bones. I recommend that y’all either take a first aid course, or check out a first aid manual for illustrations and some hands-on play. Unless you’ve made a sling a few times in practice, you probably won’t be able to do one in an emergency situation.

We’re at this year’s Farthing Party. Here’s a program item I was on this afternoon:

16h00 The Book with Everything
SF has a plethora of weird novel awards. It would be theoretically possible for one book to sweep them all. The panel attempts to brainstorm a plot that could fulfil all the requirements. Glenn Grant, Jo Walton, Marissa Lingen, Teresa Nielsen Hayden, Jim Macdonald.

I did some research in advance, listed all the awards I could remember, and came up with a set of specs that satisfied all their requirements. It was a good panel. The book, which Lis Riba christened Atlantis Nights, had a truly extravagant plot. Jim Macdonald drew a cover for it, and wrote a limerick to serve as its epigraph.

Afterwards, everyone demanded that I put the specifications up on Making Light. I said I would, but only if they promised to help reconstruct the plot. They said yes, so they’re stuck now. Here are the specs that’ll make you eligible for the Arthur C. Clarke, Aurealis, Compton Crook, Crawford, Ditmar, Eisner, Golden Duck/Hal Clement, Hugo, John W. Campbell Memorial, Kindred, Lambda, Locus (for Best First Novel), Lord Ruthven, Mythopoeic Fantasy, Nebula, Nova, Parallax, Phillip K. Dick, Plunkett, Prix Aurora, Prometheus, Rhysling, Seiun, Sapphire, Sidewise, Spectrum, Stoker, Sunburst, Tiptree, and World Fantasy awards:

The book has to be a graphic novel which is the first novel published by the author, a person of color who is an active and well-liked member of SFWA. It must be initially published in Canada, in French, as a paperback original, with simultaneous British and North American English-language editions following about ten minutes after, and a Japanese translation already in the works. It must satisfy the genre expectations of hard SF, mythopoeic fantasy, horror, alternate history, and romance, have positive gay or lesbian or bisexual or transgendered characters, and include examinations of gender, gender identity, racial identity, class, and libertarianism, while not being unsuitable for younger readers. Also, it has to have poetry in it. And a vampire.

So there I was in South Street Cemetery, Portsmouth, New Hampshire, having my own personal Buffy moment.

Nine-thirty pm tonight. It’s dark. Doyle is there with me, no one else is around. I’m wearing a black leather jacket and clutching an extinguished MagLite. Half-moon just rising behind me. I’m looking across a small pond and one of the tombstones over there is, no-kidding, glowing. Just like the book promised.

So today we drove down to Manchester in order to put elder-son Brendan on the plane back to Pittsburgh, PA, for his final year of grad school at CMU. To beguile the tedium of the journey we’d brought along Curious New England, and Doyle read aloud from it.

One of the entries begins:

Glow Stone

People in Portsmouth have a mystery among them—a baffling phenonemon that may be unique to this New England city. It seems that a light can reliably be seen in the South Street cemetery. It’s not a floating orb, a luminescent specter, or the lantern of a ghostly caretaker making his eternal rounds. It is, in fact, a glowing tombstone. Three nearly identical markers stand in a row—but only the middle one lights up. Locals have been aware of it for ten or fifteen years, many have seen it for themselves, but no one can explain it. It’s visible only at night and weather conditions seem to have little to do with it. No matter if the air is foggy or clear, it shines. Photos show it glowing amidst its darkened neighbors—a subtle luminescence, but undoubtedly there….

Well. After dropping Brendan off at the airport, and going by the Cinemagic 12 in Merrimack where we played The Game (that is, seeing the very next movie showing that we hadn’t already seen), yielding a showing of The Invasion (yet another make of Jack Finney’s The Body Snatchers), checking into our favorite Manchester motel (the EconoLodge by the Queen City Bridge (exit 4 on I-293), built in a 19th c. shoe factory, and having supper at Tinker’s seafood restaurant (paper plates, styrofoam bowls, plastic knives and forks, and entirely wonderful food), on Rt. 3 north of town, left us with nothing much to do by 7:30 pm. So the thought instantly came to me, “Why not drive to Portsmouth and look for the glowing tombstone?

The guidebook says:

Location: South Street Cemetery is in downtown Portsmouth, not far from the river approximately where South Street, Sagamore Street, and Miller Avenue intersect. Take the South Street entrance to the cemetery and walk down the descending path to the pond (on your right). Look across the pond. The stone is in the middle of three old, squarish stones in a row. Its shine can be seen from at least two hundred yards away.

More practically, take your best route to I-95. New Hampshire has the shortest seacoast of any US state with a seacoast, and I-95 runs along that coast. Get off at Exit 3, and take Rt. 33 east. 33 turns into South Street. The cemetery is at the intersection of South St. and Rt. 1-A. To the north of South Street, 1-A is called Miller Street. To the south of the intersection 1-A is called Sagamore Avenue. Just past the intersection with 1-A there are a couple of good parking areas where you can pull off the road to the right. The entrance to the cemetery is a block past the intersection with 1-A, opposite Richards Avenue.

The gate was open. Doyle and I walked past the sign that said “Closed 6:30 PM” and in. The path, the descending path, runs straight ahead from the gate. Ahead and down we went. At the bottom of the slope it was pretty dark, but there was lots of sky glow from Portsmouth and from the streetlights along Miller and Sagamore. At our closest point of approach to that pond, on the right … along a line perpendicular to that path we were walking on … by golly, there it was.

Greenish white. Not changing based on passing cars or changing traffic signals. Glowing against the hillside behind it. The tombstones on either side dark. Woo. Spooky.

Doyle didn’t want to try to skirt the pond and go overland in the dark to get closer. We walked back to the car and drove back to Manchester (through Exeter, famous for its own UFO sighting in the early ‘sixties). And here we are, back in that motel. Blogging it.

Hurrah for free high-speed wireless internet in the rooms!

* Fifty-five miles south of where I live, site of the nearest stop light (in the USA —I’m not that familiar with the closest Canadian stoplights) to my house.
[UPDATE: Curious New England and Joseph A. Citro]

A Flickr collection: Science tattoos.
Me: “You say you’d break up with me if I got a tattoo, but what if it was a tattoo of — the periodic table!?”
Chris: [thinks for a moment] “I’d still break up with you.”